The Efficacy Of Intravenous Valproate Compared To Intravenous Phenobarbital In Controlling Seizures Among Pediatric Patients With Benzodiazepine- Refractory Status Epilepticus: A Randomized Controlled Trial

Lucy Kathrina  Banta- Banzali,; Paul Matthew  Pasco,; Philomine Daphne  Obligar,; Josefa  Panlilio,

The Efficacy Of Intravenous Valproate Compared To Intravenous Phenobarbital In Controlling Seizures Among Pediatric Patients With Benzodiazepine- Refractory Status Epilepticus: A Randomized Controlled Trial

Lucy Kathrina Banta- Banzali | Philomine Daphne Obligar | Josefa Panlilio | Paul Matthew Pasco

Abstract:

GENERAL OBJECTIVE: To determine the efficacy and safety of intravenous valproate compared to intravenous Phenobarbital in controlling seizures among pediatric patients with benzodiazepine- refractory status epilepticus METHODOLOGY: Status epilepticus patients 2 to 18 years of age were randomly divided into two groups. Patients in Group A received IV phenobarbital. Patients in group B received IV valproic acid. They were followed up for 24 hours for seizure outcome and adverse events. Patients were switched over to the other group if seizures were not controlled within one hour or there was seizure recurrence within 12 hours of treatment. RESULTS: All subjects in the two groups had good outcomes of treatment: seizure was controlled in all subjects, no one left against medical advice and there was no mortality. Seizure recurrence was mainly seen during the first 12 hours in both study groups. Intravenous valproic acid and phenobarbital infusions were well tolerated. Elevation of SGPT was the most common adverse effect seen. CONCLUSION: Intravenous valproic acid is as effective and just as safe as intravenous phenobarbital as a second line non- sedative anti- convulsant for pediatric patients with status epilepticus who failed to respond to bolus doses of diazepam. RECOMMENDATION: Further prospective study to include a bigger randomized controlled trial; and given the infrequency of status epilepticus at any single institution, multicenter studies and reporting are suggested.

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